Rule Form VI Form VI
- Chapter
- Annexures · Forms and Appendices
- Text as on
- As notified 08 May 2026
FORMDefined in rule 2(k): form means the forms appended to these rules VI Part - A
[See sub rule (1) of rule 54] APPLICATION UNDER SUB-SECTION (4) OF SECTION 56 FOR COMPOSITION OF OFFENCE
1. Name of applicant :
2. Father's / Spouse name :
3. Address of the applicant :
4. Particulars of the offence:..... ......................................................................................
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5. SectionDefined in rule 2(r): section means a section of the Code of the CodeDefined in rule 2(g): Code means the Code on Wages, 2019 (29 of 2019) under which the offence is committed :
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6. Maximum fine provided for the offence under the CodeDefined in rule 2(g): Code means the Code on Wages, 2019 (29 of 2019) :
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7. Whether prosecution against the applicant is pending or not
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8. Whether the offence is first offence or the applicant had committed any other offence prior to the
offence. If yes, then, full details of the prior offence. .................................................................................................................................
9. Any other information which the applicant desires to provide
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Applicant (Name and signature)
Dated:
PART -- B [See rule 54 (3)]
Composition Certificate
Ref: Notice No.............. Date:
This is to certify that the offence under sub-section ...... of section 54 in respect of which Notice No. Dated: _____ was issued to Sh............. (Applicant), the employer of ................ (name and registration number of establishment) has been compounded on account of remission of full amount of Rs ........... (Rupees _________________) towards the composition of offences to the satisfaction of the said notice.
(Signature) Name and Designation of the Officer
Date: Place: To: ....................(Employer/Establishment) .....................(Name and registration number) ......................(Address)